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.

 

Educators’ perspectives on facilitating computer-assisted speech intervention in early childhood settings

The following paper has been accepted for publication based on work from our Sound Start Study:
Crowe, K., Cumming, T., McCormack, J., Baker, E., McLeod, S., Wren, Y., Roulstone, S., & Masso, S. (2017, in press). Educators’ perspectives on facilitating computer-assisted speech intervention in early childhood settings. Child Language Teaching and Therapy.
Here is the abstract:

Early childhood educators are frequently called on to support preschool-aged children with speech sound disorders and to engage these children in activities that target their speech production. This study explored factors that acted as facilitators and/or barriers to the provision of computer-based support for children with SSD in early childhood centres. Participants were 23 early childhood educators at 13 centres who participated in the Sound Start Study, a randomised controlled trial that examined the effectiveness of the Phoneme Factory Sound Sorter® (PFSS) computer program (Wren and Roulstone, 2013). Following the trial, participants completed a telephone interview discussing their experiences implementing the program. Transcripts from the interviews were analysed and three categories emerged as factors that influenced the provision of support: (a) Personal factors that related to the children (engagement with PFSS, inclusion/exclusion experience), peers, and educators (service provision, educator engagement, and support of child PFSS use); (b) Environmental factors that related to policies and philosophies (child-centred practice, technology), the physical environment (inclusion/exclusion), and logistics (time, technology); and (c) Program factors that related specifically to PFSS (program format, specific games, game duration). In order to best meet the needs of children, parents, educators, and clinicians, these factors need to be taken into consideration in the provision of speech and language therapy services in early childhood centres.

Digital tools to support children’s speech and language skill

The following book chapter has been accepted for publication. It is based on work from the Sound Start Study.
Wren, Y., McCormack, J., Masso, S., McLeod, S., Baker, E. & Crowe, K. (in press). Digital tools to support children’s speech and language skill. In S. Danby, M. Fleer, C. Davidson & M. Hatzigianni (Eds). Digital childhoods: Technologies in children’s everyday lives. Dordrecht, Germany: Springer.
Here is the abstract

Most children develop speech and language with ease and quickly become sophisticated communicators. For some children however, these skills are acquired with difficulty and extra support is required. A range of digital tools are available to assist with this: some of these are based on theories of speech and language acquisition while others have been developed in response to market demands. Few empirical studies of digital tools for speech and language development have been carried out though some success has been noted when facilitated by a speech-language pathologist (SLP). Given the interactional capabilities of digital tools, it would be helpful to identify whether they could achieve similar results independent of SLP support. One such tool, Phoneme Factory Sound Sorter®, was tested in a randomised controlled trial with early childhood educators delivering the intervention. Improvement in speech production varied across both groups and significant differences were not observed. However, supplementary investigations found that parents’ and educators’ were positive towards the use of digital tools and findings relating to the implementation of the intervention have been identified, which provide useful information for settings looking to use digital tools to promote speech and language skills in children.

Celebrating the end of the Sound Start Study

On 30th June, the investigators on the Sound Start Study submitted our final report to the Australian Research Council. We celebrated the official end of the Sound Start Study at CSU Olympic Park on Monday; however, we are in the midst of finalising many journal articles, book chapters, and conference presentations reporting the findings of our research.

Sarah Masso, Elise Baker, Kate Crowe, Adelaide, and Sharynne

Here in an excerpt from the report:

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 1^st 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).

Sound Start Study team meetings with Dr Yvonne Wren

Over the past 3 weeks, Dr Yvonne Wren has been visiting Australia sponsored by our Australian Research Council Discovery Grant (Sound Start Study). Yvonne is the author of Phoneme Factory Sound Sorter, the software we used during our randomised controlled trial. Yvonne was not involved in the randomisation or data collection, but has been assisting us with data analysis and interpretation as well as with writing papers while she has been in Sydney and Bathurst. It has been such a pleasure to spend extended time with her.

Sound Start Study visit to NSW Department of Education Rural and Distance Education Unit

Dr Yvonne Wren from the Bristol Speech and Language Therapy Research Unit and University of Bristol visited the NSW Department of Education Rural and Distance Education Unit on Thursday 26^th November. She demonstrated the Phoneme Factory software designed for teachers and assistants to support children with speech sound difficulties. Phoneme Factory consists of two programs:

1.     Phoneme Factory Phonology Screener provides teachers with a tool to individually assess children’s production of speech sounds and to determine if they need additional support (e.g., intervention using the Sound Sorter software, or further assessment and intervention by a speech pathologist)

2.     Phoneme Factory Sound Sorter provides games for children to play to support their speech and phonological awareness skills. The software enables teachers to individualise activities to a child’s particular needs.

The Phoneme Factory software was developed in the UK by Dr Wren and Professor Roulstone. The Phoneme Factory Sound Sorter has been adapted for the Australian context with support from the Rural and Distance Education Unit. It has been trialled in public and private preschools in NSW over the past 3 years in the Sound Start Study in association with researchers from Charles Sturt University (Professor Sharynne McLeod, A/Prof Jane McCormack, Dr Kate Crowe, Sarah Masso) and The University of Sydney (Dr Elise Baker).

Mike Tom, Kym Knight, David McLeod, Greg Alchin, and Yvonne Wren

Sound Start Study meeting

Today our Sound Start Study team met via Skype. We linked  7 people across 5 sites, 4 cities (Bristol, UK, Sydney, Albury, Bathurst) and 2 countries. This is the third and final year of the Sound Start Study - and by the end of the year we will learn whether the computerised intervention for children with speech sound disorders (Phoneme Factory Sound Sorter) has been successful. We have to continue to blind the data from our randomised controlled trial until the end of this year - so are looking forward to finding out the result.

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

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

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

    

Media attention regarding Sound Start research grant

Our recent ARC Discovery grant success has been picked up by The Australian newspaper's IT section. The reporter Jennifer Foreshew has written a story about our project titled: SoundSorter will get the toddlers talking. Her news item was in response to the Charles Sturt University media release about recent early childhood research grants. It is exciting to see an acknowledgment of the important issues about children's speech and language acquisition in a section of the newspaper that does not traditionally cover this topic.

This morning, the Sound Start research team met for over an hour via Skype (linked with Bristol UK, Bathurst, Sydney, and Albury) to discuss the modifications of the Phoneme Factory Sound Sorter software for Australian children, and other aspects of the research so that we are ready to begin in the new year.