|Sarah Masso, Elise Baker, Kate Crowe, Adelaide, and Sharynne|
SUMMARY: DP130102545 (Sound Start Study) was a large-scale clustered randomized controlled trial (RCT) examining the speech and pre-literacy skills of Australian preschoolers. It was completed as planned, on budget, and on time. The project involved mass screening of preschoolers (target n=1250; actual n=1205) in early childhood centers (hereafter sites) throughout Sydney (target n=18 sites; actual n=45 sites from 77 invitations); comprehensive assessment of preschoolers whose parents or teachers were concerned about their preschooler’s speech (target n=250; actual n=275); the development of an Australian version of innovative computer-based technology designed to target preschoolers’ speech and pre-literacy skills (Phoneme Factory Sound Sorter [PFSS]); RCT of PFSS over 9 weeks (each year) involving preschoolers with speech impairment (target n=128, actual n=123) randomly assigned to PFSS (target n=64; actual n=63) or control (target 64; actual n=57); comprehensive follow-up assessments evaluating the skills of each preschooler, immediately (target n=128; actual n=114) then 6-8 weeks after PFSS (target n=128; actual n=115), and interviews with early childhood educators (n=22) about their experience of using PFSS. A central aspect of DP130102545 was the RCT involving PFSS—technology previously shown to hold promise in improving children’s speech when delivered by a speech pathologist. In the RCT, an alternate service delivery model was tested with PFSS being delivered to preschoolers with speech impairment by early childhood educators at their early childhood centre.
RESULTS: From screening and assessments, more parents (35.1%) and early childhood educators (36.8%) were concerned about their preschoolers’ speech and language than any other aspect of development. Their concerns aligned with clinical testing, underscoring the importance of parents and educators seeking advice when they have concerns. For the RCT, a statistically significant improvement was found between time points (pre PFSS, immediate post and follow-up) for both PFSS and control groups on measures of pre-literacy skills (Aim 1a), speech (Aim 1b), underlying phonological processing (Aim 1c), and wellbeing (Aim 1d); however, there was no statistically significant interaction between group and time. That is, PFSS administered by early childhood educators, was not more effective than typical classroom practices. Considerable variability was evident within each group—some preschoolers showed impressive change in speech/pre-literacy over time; others showed little change, suggesting that specialized support delivered by speech pathologists is still needed for preschoolers with speech impairment to achieve optimal outcomes before school. Child- and family-related variables were explored to identify variables associated with change in pre-literacy and speech production status. Preschoolers who had difficulty producing polysyllabic (long) words had significantly poorer pre-literacy and phonological processing skills (Aim 2); preschoolers who had more difficulty producing polysyllabic words, and had a positive family history of speech difficulties were less likely to improve (Aim 3). Facilitators and barriers to PFSS implementation were also identified encompassing personal, environmental, and PFSS-specific issues.
BENEFITS: DP130102545 has provided new insights into parents’/educators’ concern about preschoolers’ development, the relationship between speech and pre-literacy skills, the identification of preschoolers with speech impairment most at risk for on-going speech and future literacy difficulties, and the implementation of support programs for preschoolers in early childhood settings. A large dataset has been created that will be mined to address future research on preschoolers with speech impairment, their families, and the role of early childhood centres.
OUTCOMES: This research has addressed all of the proposed objectives, and resulted in the production of 2 books; 8 book chapters; 4 peer reviewed journal articles; and 32 (including 5 invited) conference presentations across 7 countries including Australia (VIC, ACT, WA), Canada, England, Ireland, New Zealand, Sweden, United States). A further 3 book chapters and 11 journal articles are in preparation/submission at the time of this report. The PhD student employed throughout the project is due to submit her thesis (comprising 6 publications) in August 2016, and another student achieved 1st class honours for her thesis, based on DP130102545 data.
IMPACT: A submission was made to the Australian Government Senate Inquiry Prevalence of different types of speech, language and communication disorders and speech pathology services in Australia based on DP130102545; and CI-McLeod contributed to the Education and Employment References Committee: Students with disability in the school system, referring to data from DP130102545 (Hansard 25/9/15).