Supporting children with speech sound disorders during COVID-19 restrictions: Technological solutions

The following manuscript has just been accepted for publication 

McLeod, S., Ballard, K., Ahmed, B., McGill, N. & Brown, M. I. (2020, in press August). Supporting children with speech sound disorders during COVID-19 restrictions: Technological solutions. Perspectives of the ASHA Special Interest Groups (SIG17: Global issues in Communication Sciences and Related Disorders).

Here is the abstract: 

“Children are the hidden victims of the COVID-19 pandemic” (UNICEF, 2020). Timely and effective speech intervention is important to reduce the impact on children’s school achievement, ability to make friends, mental health, future life opportunities, and government resources. Prior to the COVID-19 pandemic, many Australian children did not receive sufficient speech-language pathology (SLP) services due to long waiting lists in the public health system. COVID-19 restrictions exacerbated this issue, as even children who were at the top of lengthy SLP waiting lists often received limited services, particularly in rural areas. To facilitate children receiving speech intervention remotely during the COVID-19 pandemic evidence from randomized controlled trials regarding three technological solutions are examined: (1) Sound Start Study (Phoneme Factory Sound Sorter), (2) Waiting for Speech Pathology website, and (3) Apraxia World. For the first two technological solutions, there were similar gains in speech production between the intervention and control groups; whereas, for the third solution the average magnitude of treatment effect was comparable to face-to-face SLP therapy. Automated therapy management systems may be able to accelerate speech development and support communication resilience to counteract the effects of the COVID-19 restrictions on children with speech sound disorders. Technology-based strategies may also provide a potential solution to the chronic shortage of SLP services in rural areas into the future.

 

Sound Start Study: Stages 1, 2, and 3 are complete

Stages 1, 2, and 3 of the 3-year Sound Start Study are now complete. Stages 4, 5,  and 6 will be completed in the second half of the year. Kate Crowe and Sarah Masso have done an amazing job over the three years with 1214 children being screened in stage 1. Charlotte Howland and Felicity McKellar have supported the study as our competent research assistants.

Sarah Masso working on the data files with
our research assistant Felicity McKellar

Skating Kate

Kate Crowe is a postdoctoral scholar leading the Sound Start Study (ARC Discovery Grant DP130102545). In her spare time she has been the Australian Team Manager for the Fire on Ice Senior Synchronized Skating Team that competed at the French Cup in January 2015 in Rouen, France. Here is a photo of Kate in the Macquarie Ice Rink Artistic (MIRA) competition during 2014.We are very fortunate to have such a multi-talented colleague!

Sound Start Study at ICPLA in Sweden

The Sound Start Team presented the following poster at the International Clinical Phonetics and Linguistics Association conference in Sweden
McLeod, S., Crowe, K., Masso, S., Baker, E., McCormack, J., Wren, Y., Roulstone, S. Talking and making speech sounds is of greater concern for parents and teachers of 4- to 5-year-old children than other aspects of development.

Sharynne, Sarah Masso and Yvonne Wren

Here is the abstract:

Early childhood is a time of maturation of skills including communication, motor, behavioural, social and academic learning skills. Most children succeed in these skills and are ready for school; some children have difficulties. Parents and teachers of 270 4- to 5-year-old Australian children within the first year of the Sound Start Project completed the 10 questions from the Parents Evaluation of Developmental Status (PEDS) (Glascoe, 2000) documenting areas of concern. There were 135 (50.0%) boys and 135 (50.0%) girls. The majority of children (76.3%) spoke English only, 21.1% spoke English + one other language, and the remainder spoke English + two or three other languages. Parents’ (P) and teachers’ (T) major areas of concern were children’s “talking and making speech sounds” (P=16.7%; T=16.3%), “understanding what you say” (P=6.7%; T=8.9%) and “behavior” (P=7.8%; T=3.0%). The other areas were generally of less concern: “learning preschool/school skills” (P=5.6%; T=3.0%), “getting along with others” (P=4.1%; T=4.4%), “using hands and fingers” (P=4.1%; T=4.4%), “using arms and legs” (P=3.7%; T=3.3%), and “learning to do things for self” (P=3.3%; T=3.3%). Whilst there are similarities between the concerns of parents and teachers, there were also differences. Understanding the source of these differences will be important to the planning of appropriate interventions. These comparative results show that parents and teachers identified preschool children’s speech and language as the major area of concern.  The results underscore the importance of communication assessment and intervention to support children’s transition to school.

 

Sound Start meetings in Sydney

Over the past 2 days we have had research meetings regarding the Sound Start Study in Sydney. We have traveled to be together to have a face-to-face meeting to discuss our progress, future plans, and to begin writing papers together. In attendance were Professor Sue Roulstone from (University of the West of England), A/Prof  Jane McCormack (CSU, Albury), Dr Elise Baker (University of Sydney), Prof Sharynne McLeod (CSU Bathurst), Dr Kate Crowe (CSU Homebush), Sarah Masso (CSU Homebush), Charlotte Howland (CSU Homebush/U of Syd) and Tamara Cumming (CSU Homebush). Dr Yvonne Wren (Bristol Speech and Language Therapy Research Unit) has been with us via Skype. It has been a productive two days.

Sound Start Team: Elise Baker, Kate Crowe, Charlotte Howland, Sharynne McLeod, Tamara Cumming, Sue Roulstone, Sarah Masso, Jane McCormack

Sound Start team meeting at CSU Homebush

Professor Sue Roulstone visits Australia (and Bathurst)

Professor Sue Roulstone, from the University of the West of England, Bristol, UK  is visiting Australia for a few weeks. She is an invited keynote speaker at the Speech Pathology Australia national conference. In addition, she is working with members of the Sound Start Study team (Sue is a co-investigator on the grant) and spending time at Charles Sturt University in Bathurst.

Sue and Sharynne enjoying Bathurst's autumnal weather

Today, Thursday 8th May, Sue presented a seminar to speech pathologists from across the Central West of New South Wales. The audience had traveled for hours, coming from places including Parkes, Mudgee, Orange, Dubbo, Lithgow, Canowindra, and Cowra. Here is the title, abstract, and her biography:

Mapping research onto practice with preschool children with primary speech and language impairments

The session will provide an opportunity to compare speech-language pathology practice in Australia with that identified in the Child Talk research programme in England. The focus of Child Talk is on speech pathology-led interventions for preschool children with PSLI, examining the research evidence as it pertains to current practice, with the aim of developing an evidence-based framework. The session will present key findings from the research programme including a typology of therapy and the perspectives of children and parents on interventions.

Professor Sue Roulstone with speech pathologists from the Central West

 

Biography

Sue Roulstone is Emeritus Professor of Speech & Language Therapy at the University of the West of England, Bristol and a co-Dirctor of the Bristol Speech & Language Therapy Research Unit. Sue has worked as a speech and language therapist, a manager, a researcher and an educator and was Chair of the UK Royal College of Speech & Language Therapists from 2006-2009. Her research interests include child and family perspectives, professional judgement and evaluation of speech and language therapy. She was a core member of the national research programme commissioned by the UK government following the Bercow Review of Services for children and young people with speech, language and communication needs (the Better Communication Research Programme) and is currently completing work on a large research programme funded by the National Institute of Health Research to develop an evidence-based framework of interventions for preschool children.

Sound Start update

Data collection for the Sound Start project has finished for the first term of the 2014 school year. So far Kate Crowe and Sarah Masso have recruited 23 sites and collected 505 stage 1 caregiver screening questionnaires. In addition, they have already completed Stage 2 assessments with six children from a total of 89 children who are eligible. There is one more week of school holidays before term 2, and stage 2 and 3 assessments begin. Thanks Kate, Sarah, and Charlotte (our research assistant) for all of your hard work so far.

Sound Start Study update

This has been an exciting week for the Sound Start Study.

New Team Member

We would like to welcome Charlotte Howland to the Sound Start team as our new research assistant. Charlotte is a 3rd year speech pathology student at the University of Sydney and met with myself, Elise, Sarah and Kate this week to discuss the project. Charlotte will be working 4hrs per week for Sound Start and is planning to focus on children's phonology for her honours project. 

Sarah, Charlotte, and Kate

Homebush Visit 
I visited the CSU Homebush site on Wednesday and met with Sarah, Kate, and Charlotte and had phonecalls with Elise and Jane. It was a day was full of discussion, data, and lots of good food and coffee!

Site Recruitment Update 
It has been a big week in terms of site recruitment. We currently have 13 preschools who will be participating in the study this year. In total there are approximately 600 children within the eligible age range attending these schools. There are an additional 13 preschool that have said that they are interested in participating. 

Children’s production of polysyllables as a marker for phonological processing and emerging literacy skills

Today Sarah Masso presented her PhD proposal at Charles Sturt University during her endorsement for candidature session. Sarah is a PhD candidate and research officer on our Australian Research Council Discovery Grant (DP130102545) (2013-2015) titled A sound start: innovative technology to promote speech and pre-literacy skills in at-risk preschoolers. Her PhD is designed to answer (in part) the second aim of the Sound Start Study: Use psycholinguistic theory, to

a. determine the relationship between children’s speech errors (developmental versus disordered), emergent literacy, and phonological processing skills.

b. test whether promotion of input processing skills alone will enhance speech and emergent literacy skills.

In true CSU style, her presentation occurred in 4 cities via video conference: Sydney, Bathurst, Albury and Wagga Wagga. Her presentation was well received by the invited panel members and audience.

 Here is her abstract

Children who have difficulty talking and making speech sounds may constitute up to 20% of preschool children in Australia (McLeod, Harrison, McAllister, & McCormack, 2013; McLeod & Harrison, 2009). Preschool-age children who have speech sound disorders are at significant risk of literacy difficulties (Lewis, Freebairn, & Taylor, 2002). Anthony et al. (2011) found that between 30% and 77% of children who have an ongoing difficulty with speech sound production when they start school will have difficulties learning to read. Identification of those children who will go on to have literacy difficulties is fundamental to providing targeted, effective and efficient early intervention. Children’s ability to store phonological representations, access/process phonological information (known as phonological processing), and complete phonemic-level tasks may be key to understanding their risk of literacy difficulties (Anthony, 2010). It has been suggested that the specificity of children’s phonological representations may be inferred from children’s accuracy of polysyllable productions (James et al., 2008; James, 2006). However, recent studies into the capacity of children to change the accuracy of their polysyllables suggest that this may not be a simple, linear relationship (Gozzard, Baker, & McCabe, 2008; Masso, McCabe, et al., in press). Thus, the relationship between children’s ability to say polysyllables and process phonological information needs to be explored. It is also necessary to determine whether the accuracy of children’s polysyllable production correlates with their ability to complete emergent literacy tasks. The body of work presented in this research proposal is designed to close a number of key gaps in the current evidence regarding the relationships between polysyllable speech production, phonological processing, and emergent literacy skills in preschool children who have speech sound disorders. Further, this research proposal outlines a body of work which will provide practical, evidence-based solutions to change how speech-language pathologists (SLPs) and early childhood education and care (ECEC) professionals identify and engage preschool-age children at a high risk of literacy difficulties in the years prior to commencing formal literacy education.

Sound Start data analysis

On Monday I traveled to Sydney to work with Kate Crowe, Sarah Masso, and Elise Baker on data analysis for the Sound Start project. We have completed the following assessessments:

• Stage 1 screening (parent and teacher report): 270 children
• Stage 2 screening assessment: 57 children
• Stage 3 comprehensive assessment: 21 children
• Stage 4 randomization of participants in the intervention or control conditions: 20 children

Once the intervention is over, all 20 children will be assessed twice to determine the outcome of intervention.
We will repeat this process in 2014 and 2015 with more children.

Kate and Sarah with some of the data they have collected

Sound Start meeting in Turin, Italy

During the IALP conference, the Sound Start team met to finalise the intervention protocols. Six of the seven team members were present in Turin, and Elise Baker Skyped with us for 2.5 hours from Australia (until 11:30pm her time!). It was an extremely productive meeting, where theoretical and practical issues were discussed. We are looking forward to the final stage of testing the participants (next week), then beginning the intervention phase (in one month's time).

Sound Start in Italy: Sharynne, Kate, Yvonne, (Elise), Sarah, Sue, Jane

Yvonne and Sarah discuss implementation of the Phoneme Factory software

Team building

Over the weekend, between our work in Bristol, UK and our conference in Turin, Italy, members of the Sound Start team spent time together in Paris.

Sarah Masso, Jane McCormack, Sharynne McLeod, Kate Crowe
(photographer Cathy Easton)

A productive week in Bristol, UK

The Sound Start team have had an extremely productive week visiting the Bristol Speech and Language Therapy Research Unit (SLTRU). We started the week sharing information about our research projects with the staff and students at SLTRU. The rest of the week we analyzed data, planned future data protocols, and had meetings with Paul White (University of the West of England statistician), Duncan Witham (busythings software developer), and Liz Dymond (North Bristol Trust innovations manager). Professor Sue Roulstone provided tutorials on randomized controlled trials and the history of Phoneme Factory Sound Sorter. In the evenings we continued our discussions as we explored Bristol and went on the Gromit trail in support of the Bristol Children's Hospital.

Staff and students at the Bristol Speech and Language Therapy Research Unit
with their Australian visitors

L to R: Sharynne McLeod, Sarah Masso, Jane McCormack,
Kate Crowe, Paul White (UWE), Sue Roulstone (UWE)

Five of the seven members of the Sound Start Team in Bristol
(will we ever manage a photo with all of us?)

The SLTRU is on the grounds of Frenchay Hospital -
a famous name for many speech pathologists

This Gromit was decorated to celebrate the Bristol (Brizzle) accent

Statistics

Kate Crowe, Sarah Masso, Graham Daniel and I spent last week in Sydney at the Australian Consortium for Social and Political Research Inc (ACSPRI) winter school undertaking statistics courses. Attendance at the course was supported by the Early Years Education Collaborative Research Network. The knowledge we gained will be useful to ensure that our data entry, coding, and analysis is accurate, efficient, and effective.

Our simplest (but one of the most effective) syntax that we created within SPSS was:
COMPUTE Age=DATEDIFF(DateScreen,DOB,"months").
EXECUTE.

This code meant that the SPSS program could automatically create the child's age in months from the date of birth (DOB) and the date of screening (DateScreen). We also created syntax to code all of Australia's postcodes into deciles relating to advantage/disadvantage, and all of Australia's languages.

Graham Daniel, Kate Crowe, Sarah Masso, and Sharynne McLeod at ACSPRI in Sydney

First set of data for Sound Start study

This week, while I have been in Viet Nam, Kate Crowe and Sarah Masso have collected the first set of screening data for our Sound Start study. Our aim is to collect screening data on 300 children this year - so it is exciting that the screening phase has begun.

National Ethics Application Form

The last two weeks have been filled with preparing a National Ethics Application Form (NEAF) to undertake research for the Sound Start project. On Friday, we submitted our 107 page application to the Charles Sturt Human Research Ethics Committee for their consideration.
Thank you to Kate Crowe and Sarah Masso for their huge efforts in pulling this together working closely with the rest of the Sound Start team: Sharynne McLeod, Elise Baker, Jane McCormack, Yvonne Wren, and Sue Roulstone.

A Sound Start begins

Today (Monday 11th March) our ARC Discovery Sound Start Project officially began. Sarah Masso and Kate Crowe have begun the task of preparing to undertake this large 3 year project. After eating cake (pictured), their next task is to write our ethics applications. Today also marks the beginning of Sarah's PhD studies. She will be supervised by Dr Elise Baker, Dr Jane McCormack, and myself. Her PhD will be based on an aspect of the Sound Start Project. We all are looking forward to an exciting three years ahead.

A Sound Start is about to start

Last year we were awarded the following Australian Research Council (ARC) Discovery Grant: A sound start: Innovative technology to promote speech and pre-literacy skills in at-risk preschoolers (DP130102545).

Here is an overview of the project:

Speech impairment affects one in five Australian preschoolers. If the problem persists into the school years between 30% to 77% of these children will have reading difficulties. Without specialist services, these children face increased risk of life-long social, educational, vocational limitations. Three challenges exist: identification of preschoolers most at risk, development of strategies for targeting both speech and pre-literacy skills, and provision of appropriate specialist services. This project will determine if an innovative computer-based service, delivered within preschools, can address these challenges by promoting age-appropriate speech and pre-literacy skills in children with identified risk of reading difficulties. 

The project team are:

• Chief Investigators: Sharynne McLeod (CSU), Elise Baker (University of Sydney), Jane McCormack (CSU)
• Partner Investigators: Yvonne Wren and Sue Roulstone (University of the West of England)
• Project Officer: Kate Crowe
• PhD Student: Sarah Masso

The project will run from 2013 - 2015. The team met in Sydney on Thursday and Friday to plan for the project to commence in March. There is a lot to organise; however, we are looking forward to the challenges and anticipate outcomes that will be of benefit to children with speech difficulties.

Kate Crowe, Sarah Masso, Sharynne McLeod, Jane McCormack, Elise Baker

    

Successful grant application: A sound start

Today we learned that our recent Australian Research Council Discovery Grant application has been funded for 2013-2015. There were several other grants awarded to colleagues in the Early Years Education Collaborative Research Network, RIPPLE, and Charles Sturt University. This years' success rate was: 21.37% so we are thrilled to have been amongst the successful applications.

Here are the details of our successful grant:

TITLE: A sound start: Innovative technology to promote speech and pre-literacy skills in at-risk preschoolers (DP130102545).

INVESTIGATORS: Sharynne McLeod (Charles Sturt University), Elise Baker (The University of Sydney), Jane McCormack (Charles Sturt University), Yvonne Wren, Sue Roulstone (University of West of England, UK)

SUMMARY OF THE PROPOSAL: Speech impairment affects one in five Australian preschoolers. If the problem persists into the school years between 30% to 77% of these children will have reading difficulties. Without specialist services, these children face increased risk of life-long social, educational, vocational limitations. Three challenges exist: identification of preschoolers most at risk, development of strategies for targeting both speech and pre-literacy skills, and provision of appropriate specialist services. This project will determine if an innovative computer-based service, delivered within preschools, can address these challenges by promoting age-appropriate speech and pre-literacy skills in children with identified risk of reading difficulties.

The news arrived while Elise Baker was visiting me, and we were overwhelmed by the number of congratulatory emails and phonecalls that arrived from colleagues. We fitted in a celebratory lunch with Professor Jennifer Sumsion (who was a chief investigator on another successful application) and Professor Linda Harrison and Associate Professor Fran Press who found out about their promotions at the same time.

L-R: Julie Martello, Fran Press, Elise Baker, Jennifer Sumsion, Linda Harrison, Sharynne McLeod